Help me understand, if you will, where the soul of meaningful use lies. I’ve seen the rules that have been made final and I’ve heard the stories of folks in the field that have had their lives and practices changed because of it.
But all of this just doesn’t seem to lead to a very innovative end.
Sure, the technology is needed in healthcare as the antiquated use of paper continues to overwhelm, but what’s the real proposition here? As far as I’m concerned, some of the real questions remain unanswered, and I am slightly suspicious as to why the feds are so heavily involved.
Granted, I shouldn’t be surprised given all the money that’s been spent in numerous non-government areas (like cars, banking and solar), but let’s peel back here a little and ask why the industry really needs the incentives. Let’s agree that on its own, the healthcare industry would have adopted the technology and was doing so; the incentives just moved adoption along much more quickly. So, why are the feds involved? Agree with me or not, they want our data.
This is the coup d’état. Collected data leads to predictive analysis and evidence-based treatment protocols. This leads to the dissolution of independent care protocols and removes independent will and turns healthcare into committee care.
Getting care is going to be similar to applying to government grants and scholarships. I’m oversimplifying the matter here, but please, let’s admit that there is a price that’s going to be paid for the federal incentives.
That said, my soap boxing out of the way, I’m back to my original question: Where is the soul of meaningful use?
Let’s take a look at the upcoming Stage 3. In large part it’s a lot of increased measures and new “patient engagement” provisions such as: giving patient the opportunity to request amendments to their records online, requiring electronic health records to receive, generate or access appropriate immunization recommendations, and requiring EHRs to be able to query other entities for outside records.
(Yawn.) (Wipe my eyes.)
These are valiant efforts and worthy of exploring, certainly. But, where is the real innovation that we’re supposed to be seeking? Where’s the game-changing approach to healthcare information that blows our minds? This is a technology based process after all and I think we need to begin demanding more of the technology we employ.
The technology is not holding us back, either. It’s us and our continually lowered expectations. If we’re going to take some risks then those risks need to be real risks and not some marketing speak for a data grab slight of hand.
From my perspective, about 90 percent of the technology vendors in the space do just enough and nothing more. Their investments are in sales teams, not in research and development.
But how can you blame them when the one leading body of the mandated changes is asking so little of the community.
What this is beginning to feel like a bunch of self-appointed “decision” makers trying to affect change of a program that’s been in place for decades, in the end, no matter the tinkering, may be nothing but waste having been accomplished.
HIE expansion about supply and demand? Well, if you read this blog regularly, you’ll know that I spend a good bit of time perusing HealthIT.gov. Though it’s not flashy and overwhelming, the site is informative and actually provides a great deal of information, which says a lot since it’s a government property.
What HeatlhIT.gov does well is provide a nice primer of information about a variety of subjects from meaningful use, electronic health records and health information exchanges.
In addition, the site puts everything in plain and simple language for all the world to understand.
For example, take a look at the reasons why health information exchanges are important to the healthcare landscape:
The ability to exchange health information electronically is the foundation of efforts to improve healthcare quality and safety. HIE can provide:
The connecting point for an organized, standardized process of data exchange across statewide, regional and local initiatives
The means to reduce duplication of services (resulting in lower healthcare costs)
The means to reduce operational costs by automating many administrative tasks
Governance and management of the data exchange process
And for good measure, here are a few examples of how health information exchanges are benefiting the healthcare landscape. Some of these concepts are a bit obvious and overstated here, but still this provides a nice starting point in support for the soon to be possible movement.
Benefits of health information exchanges:
Provide a vehicle for improving quality and safety of patient care
Provides a basic level of interoperability among EHRs maintained by individual physicians and organizations
Stimulates consumer education and patients’ involvement in their own healthcare
Helps public health officials meet their commitment to the community
Creates a potential loop for feedback between health-related research and actual practice
Facilitates efficient deployment of emerging technology and healthcare services
Provides the backbone of technical infrastructure for leverage by national and state-level initiatives
I’m not alone in the belief that I feel HIEs’ most important role is one of creating interoperable opportunities to connect physicians and their patients to a web of other care givers and health community members.
It seems that the closer we get to HIEs and their overall acceptance in healthcare, doesn’t it seem like we take two steps back?
What are some of the hurdles keeping HIEs from reaching their full potential? Glad you asked.
Cost has to be the clear front runner. As I’ve previously stated, the questions remain – who’s going to pay for them? The government clearly wants a healthy HIE community because it is believed that they will lead to greater adoption of EHRs while vendors want part of the action so they can charge physicians to transfer data through the networks. Vendors can’t figure out a financial model for them and until they can get someone to pay for them, there may be little movement here.
Another hurdle of HIEs is that for those that exist, the data often exists in silos. Problem with siloed data is that the data doesn’t go anywhere. Sounds a lot like an EHR, but an EHR may be more user friendly and robust. Just saying.
Finally, lack of standards impede their advancement. More development for standards is required for the variety of HIEs to be able to communicate. Profiles, like the need for structured data in EHRs, will help advance the cause and promote their development.
Ultimately, HIE expansion will most likely come down to basic business 101: supply and demand. When the population demands it, we’ll see the supply increase and in so doing, we’ll see cost containment, industry wide standards and completely interoperable systems that will completely open up the health IT market place.
Healthcare big data is a big story, and it’s only going to continue being one. It’s a story I like and am intrigued by, but it’s not very sexy. Because of this, the only pieces of information about it seems to be very technical.
Until we actually see how big data changes lives, there’s just not going to be warm and fuzzy stories about it. So, cold and technical it is; nonetheless, I’m still fascinated.
In searching information about the subject, because I too want to know more from a ground floor level, it was nice to come across a nice piece about big data on the Cleveland Clinic’s website.
So, getting right into it, here’s an interesting piece of trivia about healthcare big data directly from the Clinic: “The amount of data collected each day dwarfs human comprehension and even brings most computing programs to a quick standstill. It is estimated that 2.5 quintillion bytes of data are created daily, so much that 90 percent of the data in the world has been created in the last two years.”
Healthcare big data is essentially large amounts of data that’s difficult to manipulate using standard, typical databases. Essentially, big data is very large pieces of information that ultimately, when captured can analyzed, dissected and used to monitor segments within a given sect.
Healthcare big data, it is thought, is what will drive change in care outcomes. What’s interesting, though, is that even though there’s a tremendous amount of data available for use, it’s just not being collected in a structured manner.
Collecting structured data is a must if we are going to begin putting some muscle to the bone of the new healthcare ecosphere we’re putting in place. You don’t have to take my word for it; IDC Health Insights research director Judy Hanover spoke of the same subject recently here.
But, to prove my position, I’ll let Cleveland Clinic make the point: “Unfortunately, not enough of this deluge of big data sets has been systematically collected and stored, and therefore this valuable information has not been aggregated, analyzed or made available in a format to be readily accessed to improve healthcare.”
Also according to the Clinic, if all of the data currently available were used and analyzed, it would be worth about $300 billion a year, reducing “healthcare expenditures by almost 8 percent.”
At the heart of healthcare big data is the hope that it can eventually help providers become predictors. Essentially, big data is like a big crystal ball, or so it’s been said.
According to Cleveland Clinic: “In this way, analytics can be applied to better hospital operations, track outcomes for clinical and surgical procedures, including length of stay, re-admission rates, infection rates, mortality, and co-morbidity prevention. It can also be used to benchmark effectiveness-to-cost models.”
Predictive analytics: That’s what it’s all about.
With all of the attention being given big data and warnings about being prepared for big data so it doesn’t sneak up on you – like meaningful use and ICD-10 – are valid and should be taken seriously.
Efforts are currently underway and available for big data processing and by managing data, “This dynamic data management technology makes data analysis more efficient and useful. Access to these data can also significantly shorten the time needed to track patterns of care and outcomes, and generate new knowledge. By leveraging this knowledge, leaders can dramatically improve safety, research, quality, and cost efficiency, all of which are critical factors necessary to facilitate healthcare reform,” writes Cleveland Clinic.
Big data is a catalyst for change, and without sounding caustic, will be a bigger deal than electronic health records currently are. Without a commitment to it, practices and healthcare systems will be left behind.
The misconceptions about healthcare information technology, specifically electronic health records, are rampant even as the technology matures and begins to saturate the market.
More of the technology’s capabilities are known now by the average healthcare insider (physician, practice or hospital leader, for example) than even two years ago (before meaningful use). That’s understandable; however, those darned misconceptions continue to fly.
No matter where you look, there’s a top five or a top four and even a top three list of the biggest misconceptions about the technology.
So, today I thought I’d take a look at some of the “best” misconceptions about EHRs floating about the health IT stratosphere.
Electronic health records won’t save a practice any money: Though they alone may not save money from the moment go, over time and if implemented properly, they can help a practice save money in the long term. Ultimately, they create internal efficiencies such as reduced paper, easier and safer transfer of records to patients and specialists, reductions in the number of tests that need to be ordered, greater coordination of care. Plus, for some practices utilizing EHRs they’ve been able to increase the number of patients seen because of improved administrative functions.
Using technology in the exam room distracts patients and reduces the quality of the visit: Frankly, this is nothing more than a statement made without substance, and there’s really no difference between taking notes on paper or through a piece of technology from the patient’s perspective. Additionally, we all live in a technology filled world and patients are accepting of technology in their lives. In many cases, patients see technology in the exam room as a way to engage their physicians in their care. Physicians should see it the same way.
Electronic health records are not as safe and can be hacked: Never say never, and yes, there’s a bit of truth to that statement, but the fact is that paper records are simply easier to access than their electronic counter parts. And, since most data breeches are inside jobs, at least electronic health records allow for electronic auditing which can determine who, when and how often a record has been accessed.
EHRs are hard than paper to use: Perhaps depending on your comfort with your system, this may be the case, but clear investment in learning the system will pay long-term dividends. Electronic health records allow for searchable records with data that can be viewed, shared, downloaded and “filed” without having to print, manually scan, review and file the documents.
Electronic health records were created to facilitate meaningful use: Quite frankly, this is false. Clearly, EHRs have been available long, long before meaningful use was even a concept. They do facilitate meaningful use now that the process has been put in place for the program to thrive.
An electronic health record assures a practice of meaningful use: Not so. An EHR is the first step in the process. Meaningful use is about the process of using the technology and about using the data gained to improve patient health outcomes. Seeing the patient populations’ data allows physicians to begin to make changes to their approach to care, especially as it relates to chronic conditions.
Electronic health records are not available for every practice: There’s no way to objectively respond to this misconception. Truth is, there are hundreds, maybe even thousands of systems on the market, some of them designed for specialty specific practices. If you have been dutiful in your research and still determine that nothing meets your needs, either you aren’t ready or willing to make the switch or you are impossible to please.
Electronic health records can build patient loyalty. And using them within a practice and letting patients know about them and their uses, it is more likely that patients will return for service again in the future.
At least that’s the latest news from Kaiser Permanente.
Also according to the health plan/care provider is that patients are more loyal to a practice using an EHR if the practice is also using a patient portal for the patient to access their personal health records.
Accordingly, people using Kaiser’s personal health record to track their health, manage their care and access records through Kaiser’s My Health Manager (the organization’s patient portal) were more likely to stick with the Kaiser health plan than not in future plan years.
Though I maintain my fair share of skepticism about the study featured in the American Journal of Managed Care because Kaiser members are incredibly loyal (I know because I’ve worked with Kaiser members as a benefit plan communications director for a major government program in the region where the study was conducted) and they probably would not have switched plans regardless of the patient portal (and because the study seems somewhat self serving of Kaiser), there may be a nugget of truth here.
Apparently, according the study, Kaiser plan members who used the portal to view their medical records, make or change appointments and communicate with their doctor or other health provider electronically, where more likely to continue to pick the same plan in subsequent plan years.
The results are derived from more than 160,000 Kaiser Permanente Northwest members enrolled in a Kaiser plan between 2005 and 2008. Members who used the portal were more than twice as likely as nonusers to stay with the health plan during the period studied. “The only greater predictors of retention likelihood were more than 10 years of plan membership and a high illness burden,” the study authors wrote.
Essentially, the authors of the study suggest that EHRs integrated with a patient portal are more likely to create loyal patients.
Really, though, the findings of this Kaiser study are nothing new. As have been reported numerous times before, patients continually perceive healthcare technology positively, at least according to my perspective.
In the survey, patients said they felt more comfortable with physicians that used an EHR system, and more importantly, patients felt that the information contained in the medical record was more accurate when they physically saw information being entered electronically. Physicians using EHRs in front of their patients said they felt the most comfortable with the accuracy of the information contained in their records.
Additionally, in the survey I conducted, 45 percent of patients had a “very positive” perception of their physician or clinician documenting patient care with a computer or other electronic device, and patients believe that using an EHR will actually improve care outcomes in the long term.
Physicians and patients also agreed on the benefits of using electronic devices to document patient care during an encounter. The most important benefits of EHRs, as agreed upon by the two groups, were
They give physicians access to patients’ medical records and history in real time.
When appropriate, EHRs help the physician securely and seamlessly share information with other doctors, pharmacies and payers.
EHRs help physician make good decisions about patient care, ultimately driving the quality of patient care.
To put it bluntly, yes, there appears to be a great deal of patient loyalty for physicians using an EHR. Kaiser’s data only seems to strengthen this claim, and, certainly, it appears that integrating technology that’s “interactive,” such as a patient portal, helps foster this connection.
If nothing else, using an integrated EHR seems to generate greater patient engagement and may create more loyalty toward a practice, which ultimately builds stronger practices and potentially more word-of-mouth customer referrals, which help businesses grow.
Does healthcare technology actually interfere with patient care? Apparently so, according to a new study commissioned by athenahealth.
“Overburdened” physicians face pressures from continual government “intervention,” “increased use of and frustration with EHRs” and “administrative burdens.”
According to the study, physicians are disenfranchised.
Why? Well, according to athena’s study, there’s too much change. Perhaps that’s a bit of a blunt summation, but it seems to be the picture the study paints.
Nearly half the physicians interviewed for the study said electronic health records were not designed with the physician in mind while nearly two-thirds said the EHRs take away from their ability to engage with patients.
Some of this is obviously subjective opinion. Of course, there’s really no way to measure whether or not patients feel put off by their doctors entering data during the visit. On the contrary, there are plenty of reports to suggest that patients actually appreciate that doctors use an EHR during the visit.
However, from the eye of the beholder (physicians), they’re the ones sitting in the practice day after day getting a feel for the moods of their patients in the exam room once the keyboard comes out.
Sadly, the conclusion they have come to as a collective population is that EHRs are significantly reducing the quality of care patients receive. Again, this is filled with opinion, but if it’s the mood conveyed, that mood is bound to rub off on the patient population and will affect their perception of the technology, too.
These same physicians – more than 80 percent of physicians in the study – also feel the future of the independent practice is not viable, and more than two thirds feel the quality of care will greatly diminish over the next five years because of all these continuous distractions, including technology’s pervasiveness in the practice space.
This is stark “reality” for the profession from the mouths of its professionals.
Interestingly, in a completely unrelated study by recruiting firm Jackson Healthcare, more than a third of private practitioners say they will quit private practice within the next 10 years because of “declining reimbursement, capitation, and unprofitable practice; business complexities and hassles; overhead and cost of doing business too high.”
Where they’ll likely end up is obvious: in a hospital setting or in a hospital-owned practice. Why leave? They said they fear economic factors facing private practice (the first reason given) and they don’t want to practice in the age of reform (second response), which may be quite difficult given the current climate of healthcare.
What does all of this eye-opening information mean?
Well, it doesn’t bode well for those concerned about the ever increasing shortage of healthcare providers.
Perhaps more troublesome, though, is that no matter how much time is spent educating and informing certain segments of the healthcare population, there are always going to be many who remain unconvinced that technology produces practice efficiencies and helps lead to better care outcomes.
Patient engagement will continue to become more popular as consumers take greater ownership of their care and begin to discover that their health information should actually be easier to access because of electronic health records and patient portals. However, patients must have reason to engage for this trend to become less of a trickle and more of a flood.
Healthcare technology is meant to allow more access to, and increase the availability of, patient’s health information. At least that’s one of the desired outcomes of the push (meaningful use and federal incentives) to lure physicians to adapt the systems.
Sterling Lanier, CEO of Tonic Health, succinctly sums up lack of patient engagement in a recent editorial published by For the Record magazine.
In it, he states that healthcare, like government, is filled with vernacular and jargon – HIEs, EHRs, ACOs, HIT, et al. – and the more these terms continue to be used, the less likely patient consumers are going to interact and engage with the healthcare community, and to take ownership of their own care outcomes.
As Lanier notes, and as I have often thought, to bring patients into the conversation, they have to be treated like consumers and they must have a reason to “buy” into the system. In this case, consumers must “buy” the information given to them. If they buy and own it, they’ll want more of it, or so goes the prevailing thought.
But simply speaking in terms the natives will understand isn’t enough. Consumers need to better understand how the technology they encounter at the doctor’s office helps produce better care outcomes. They may need some education and certainly they need some engagement once the systems are in place and being used during the visit.
Though patients will interact with the EHR less frequently than other technology they encounter, such as the patient portal (which they can actually use and interact with on their own), that doesn’t mean the EHR should be ignored during the interaction or treated as a foreign concept. In most cases, let’s remember, healthcare is actually behind many other consumer markets so consumers are actually more versed in the use and capabilities of similar systems outside their doctor’s office. Besides, we’re like children with devices and must test drive things like smart phones, televisions and computers as we learn to use them; we like to get our hands on the technology to try it out to satisfy our child-like need to see with our hands.
Even though patients can’t “touch” their EHRs, we can watch the information we provide our doctors being entered into the system; we can speak with our caregivers as they toggle and tab; and we can engage clinicians as they review our profiles and medical records. As a patient of a doctor with an EHR, I ask questions about the system: what it does, who makes it, why it was chosen and if it layout closely resembles the clinics’ past paper charts. I feel better about the little details and doing so makes me feel as though my doctor is listening to me during the visit.
Asking me these questions engages me more in my healthcare, and more than likely, engages my doctor in my care and outcomes.
Another day, another EHR survey, and once again it’s about the security of information contained in electronic health records.
Apparently, according to this latest survey, more needs to be done to educate patient consumers of the value of the healthcare technology they encounter in their physician’s offices even though more than 50 percent of respondents said they feel EHRs are better than paper charts. Specifically, in this survey patients feel their personal information contained in the EHR is vulnerable to security breaches or hackers.
The data captured in this survey is not surprising, nor is it anything new. In fact, the following statement came from an April 2011 survey I administered for a major healthcare software vendor and announced to the press:
“While both physicians and patients believe that EHR will help improve the quality of healthcare, both groups have concerns about privacy and the security of EHR.” – April 26, 2011.
Though many people think the burden of educating the public about the benefit of EHRs should be placed on physicians, I disagree with this stance.
Physicians, frankly, are consumers of EHRs, just as patients are. It’s an unfair burden to put a group of consumers in the position of advocates for products they pay to use. In what other commercial industry do the manufacturers and retailers of products leave the education of the product to consumer? Correct me if I’m wrong, but I can’t think of any.
The burden of educating consumers about the value and importance of EHRs should fall to the EHR vendors. After all, the vendors are the experts of their products’ capabilities, not the physicians. Automatically electing physicians into this role is unfair.
When I represented an EHR vendor, we brought our message to physicians and patients. Get patients to realize the value of EHRs and you drive them to persuade their physicians to adopt the systems. Our stance meant we held ourselves responsible for educating the market about our EHRs’ capabilities. We didn’t feel that it was right to put our physician clients in the position of becoming product advocates unless they wanted to be. Advocating our products was our job.
As patients become more familiar with EHRs, they will fear them less, just as happened with online banking and shopping. Familiarity and comfort with these systems have changed and so have consumers’ perception of them; the same will ultimately happen for EHRs.
According to the latest Centers for Disease Control and Preventions’ National Center for Health Statistics survey of 2011 EHR adoption trends, released on July 17, use of EHRs is up to 55 percent of practicing physicians. That’s a 5 percent increase from 2010, also according to a CDC survey.
The survey of 3,180 physicians was funded by the Health and Human Services Department’s Office of the National Coordinator for Health Information Technology. More than 55 percent of all physicians use and EHR (and more than 86 percent of physicians in practices with 11 or more physicians use an EHR). Physicians also value their current EHRs more compared to past iterations of the systems and, finally, respondents said the care they provide to patients is better than in the past because of the EHRs.
Problem: there’s no data in the survey to support this final claim.
Obviously, EHRs are intended to improve care, whether at the individual level or at the practice level. However, physicians accessing patient data through the records should be tracked and made quantifiable.
Practices using EHRs have the power to change lives for the better, manage care and ensure proper care is provided throughout a patient’s care plan. Practices can and should track how care initiatives have changed with the implementation of an electronic health record and how their patient populations’ health benefits.
Simply stating that patient care has improved when a practice uses an EHR is an immeasurable statement. Innovative practices find ways to track these outcomes whether it means there are fewer chronic conditions among their patients or that their patient populations’ life expectancy actually increased over a period of time (as can be measured and in some cases has been done).
The ONC needs to do more to encourage physicians to move beyond meaningful use stimulus, which is driving the increased use of EHRs. And while the data collected from surveys such as this are important, as I continue to say, they don’t tell the whole story of how technology can improve healthcare.
And throwaway statements indicating immeasurable “facts” does nothing more than generate misleading headlines.
We read the data and follow the numbers. Facts don’t lie. Technology can, and does, help improve health outcomes. People’s lives can be improved. Trends can be found and issues addressed.
It’s much less common, though, to hear about how these devices, this technology – electronic health records, for example – are used at the care level in the practice or at the hospital.
Not necessarily the “thought leaders” in the industry, doctors and administrators down the street use this technology to build more efficient business, grow practices and create jobs. The technology allows practices to accommodate the increased number of patients that can be seen each day because a practice management system helps streamline operations so succinctly.
In another world, in a land where the term “thought leaders” is not known, a physician toils her way through an impoverished, uninsured community providing education and ensuring her chronically ill patients are receiving the care they need when they need it, even if she’s conducting house calls and working seven days a week to meet the community’s need for healthcare. How she uses or doesn’t use her technology affects lives. How? You’ll find out soon.
Healthcare technology allows worlds to merge. Distances between providers and their patients are reduced to nothing more than access to a connected device and a Skype account.
But promises delivered are not always dividends gained. Along with the highs, there have been lows. The technology still is not perfect, but for all problems there are typically workarounds.
And while questions will always remain, and thought leaders, government officials and vendor leaders convene to help make things more meaningful, every day folks will continue to run every day practices in every day areas of the world, with or without the help of their technology and technology partners.
Their stories and more – views, observations and opinions — are here at Electronic Health Reporter: at the heart of healthcare, where you live.